# IDAHO COUNTY DERMATOLOGY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922835859
- **Authorized official:** JEANNA RENDO NP-C (OWNER/PROVIDER)
- **Authorized official phone:** (208) 695-6668

## Contact information

- **Practice address:** 113 S A ST, GRANGEVILLE, ID 83530-1428
- **Practice address phone:** (208) 695-6668
- **Mailing address:** 113 S A ST, GRANGEVILLE, ID 83530-1428
- **Mailing address phone:** (208) 717-4940
- **Mailing address fax:** (208) 717-4990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2024
- **Last updated:** 02/07/2025